Lead/Presenter: Erica Svojse, COIN - Houston
All Authors: Svojse EK (VA HSR&D Center for Innovations in Quality, Effectiveness and Safety; Michael E. DeBakey VA Medical Center, Houston, TX), Brown-Griffin CR (VA HSR&D Center for Innovations in Quality, Effectiveness and Safety; Michael E. DeBakey VA Medical Center, Houston, TX ), Petersen LA (VA HSR&D Center for Innovations in Quality, Effectiveness and Safety; Michael E. DeBakey VA Medical Center, Houston, TX ) Hysong SJ (VA HSR&D Center for Innovations in Quality, Effectiveness and Safety; Michael E. DeBakey VA Medical Center, Houston, TX )
We aim to explore how team dynamics, particularly team cohesion and psychological safety, impact the effectiveness of an audit and feedback intervention aimed at improving coordination in primary care teams.
This research covers the qualitative aspects of a larger, 3-part audit-and-feedback study (Hysong et al, 2015). Ninety-eight clinical personnel from 34 Patient aligned care teams (PACT) at four Department of Veterans Affairs (VA) healthcare facilities from two regional networks enrolled in the study. Fieldnotes were produced by trained researchers/facilitators immediately following each session with the PACT/clinic and were analyzed using a grounded theory approach.
One group (A2) was found to be highly cohesive, five were moderately cohesive and two had no instances of codable cohesion within their debrief sessions. Group A2 also had the highest evidence of psychological safety; five of the other groups were in the midrange and two scored low. We also observed the teams went through a series of cycles: 1) Learning, 2) implementing, 3) "speed bump", 4) recovery and 5) successful implementation. Although all groups went through steps 1-3, only three of the groups moved on to steps 4-5. Those with higher instances of team cohesion and psychological safety were most able to move through all stages, particularly from the speed bump into recovery stage. This indicates a correlational relationship between these constructs.
When team cohesion and psychological safety are low, the PACT is unable to move through the cyclical setbacks every team faces such as turnover, personality conflict or workplace stress to the same extent as those PACTs for which cohesion and psychological safety are high. In turn, this prevents PACTs from fully utilizing tools such as the one presented in this intervention.
The PACT system is intended as a more modern, efficient and coordinated method of care for veterans, in which VHA has invested hundreds of millions of dollars. This work shows that there are potential barriers to the PACT systems' optimal performance. This means greater resources must be allocated towards identifying and implementing ways to increase PACT cohesion and psychological safety in order to ultimately increase patient care.